[Objective]To examine the safety and efficacy of closing-opening wedege osteotomy for angular kyphosis.Seven patients with angular kyphotic deformity of the thoracic or thoracolumbar spine were treated by closing-opening wedge osteotomy using a single posterior approach.[Method]Seven patients with angular kyphosis were treated.The apex level of kyphosiswas T5 in one patient,T11 in one,and T12 in five.There was old fracture in five patients,congenital deformity in one,and neurofibromatosis in one.The first 30?~35? of kyphosis were corrected using the closing wedge technique with the hinge of the anterior longitudinal ligament after veretebrectomy and circumspinal decompression of the spinal cord.Then the hinge was moved posteriorly to the spinal cord and the remainder of the requisit angle of osteotomy was corrected using the opening-wedge technique(closing-opening wedge osteotomy).Spinal curvature was stabilized using posterior instrumentation and graft.[Result]Localized kyphosis was reduced from and average of 67? to 18? at 2.2 to 7.5 years ' follow-up.Sagittal alignment from T1 to the sacrum became more physiologic than before.There were no neurologic complications.Bony fusion was achieved in all patients,and there was no correction loss.[Conclusion]Satisfactory correction is safely performed by closing-opening wedged osteotomy with a direct visuzlization of the circumferentiall decompressed spinal cord.Although the performance is technically laborious,it offers good correction without jeopardizing the integrity of the spinal cord.

[Objeetive] To investigate the effect of minimally invasive V-shaped osteotomy instead of traditional operative technique for correction of ankylosing kyphosis.[Method]The C-arm X-ray was used under the local anaesthesia to select the space of osteotomy,the length of incision were 6~8 cm and only exposed one interlaminal space,the width of laminar V-shaped osteotomy were 8~10 mm.The operating table was changed from reverse V to type after finished osteotomy,the space of osteotomy would be automatica ly closed and replaced,if the space could not be automaticly closed,careful manipulation would be applied to close it.The bone mass of osteotomy was used in posterior bone graft of lamina.Postoperation,stric and standardized regulation were performed to send the patient back to ward.The fractional manual correction and external fixation of hyperextended plaster vest were performed respectivly 2 weeks after operation.[Result]Fifty patients of this group acquired more satisfied results except 1 case appeared recurrent deformity due to early removing of the plaster vest.[Conclusion]Minimal damage,lower medical expenses(without internal fixation)and satisfied results demonstrated the minimally invasive V-shaped osteotomy is a very effective method.It has advantages of Mutual intercalated V-shaped osteotomy space and better stability after reduction,posterior bone graft of lamina and external fixation of hyperextended plaster vest,therefore,all patients can acquire the bone graft fusion afer 6 months.

[Objective]To introduce the operative method and clinical experience of 200 cases with halo pelvic distraction and elastic growing rods fixation for treatment of scoliosis during growing period and comparison with pedicle screw systems. [Method]According to the principle of Harrington hook-rod system,inferior extremity was one hook hanged on the total lamina of lumbar vertebrae and superior extremity were two hooks hanged on the inferior articular process of thoracic vertebrae,rod I and rod II were connected by joint,between the end of rod I and joint set the spring cover for automatic extension followed spine growth.For the longer growing period children,the small incision could be performed between the hook and rod for fractional distraction to help the spine longitudinal grown until skeletal development and maturation.[Result]The average rate of correction of 200 cases with Scoliosis were 70.32% after 2~15 years follow-up survey,the height of the patients were increased by 5~22 cm and the preserved range of spinal motion was better than pedicle screw systems in long term follow up.Incidence of hook displacement was 2% and rod breaking was 3%.Reasons of hook displacement and rod breaking was related to unfitting installation and methods of internal fixation,incidence of hook displacement and rod breaking were decreased significantly post reform.[Conclusion]Halo pelvic distraction and elastic growing rods fixation for treatment of scoliosis during growing period which is a kind of biological method,does not affect the longitudinal growth of spine and prevent the complication of crankshaft phenomenon caused by pedicle screw systems.

[Objective]To sum up the experience of wearing the halo pelvic and level traction costoplasty to treat 35 cases of severe scoliosis combined with collapsed chest. [Methods]When scoliosis of patients were corrected to a certain degree after three weeks of halo pelvic distraction, the most serious collapsed ribs of concave side of the curve underwent a transverse incision the cross ribs. A special rib bender was used to bend the exposed 3 to 6 ribs. The bent ribs were pulled up by double-stranded 10# thick silk which was extended out through the skin and fixed in the upright post of the instrument of Halo pelvic distraction with rubber membranes.[Results]Thirty-three in 35 patients underwent costoplasty. The collapsed chest was turned round, respiratory function improved significantly and cyanosis of lips and nail bed disappeared. These offered advantages for next scoliosis correction.Two patients failed to undergo costoplasty due toprimary pulmonary atelectasis and pulmonary deficiency.[Conclusion]The instrument of Halo pelvic distraction is a good and convenient fixed point. Bending and turning round ribs can provide a convenient condition for recovery of collapsed chest. Halo pelvic distraction can be used not only for scoliosis correction but also for costoplasty.

[Objective]To report a new surgical technique of total en bloc spondylectomy for complete resection of primary spinal malignancy and for oncologic curability.The conventional approach for primary spinal malignancy is via intralesional piecemeal resection,and very few reports have described en bloc extralesional resectioning with histopathologically wide or marginal surgical margins.[Method]Total en bloc spondylectomy,consisting of en bloc laminectomy and en bloc corpectomy followed by anterior instrumentation with spacer grafting and posterior spinal instrumentation,was performed in five patients with primary malignant tumors and two patients with giant cell tumors.Patients were observed for 2 years to 6.5 years,except for one patient who died 7 months after surgery because of mediastinal metastasis.[Result]All patients attained significant clinical improvement after surgery with no major complications except one.Histologically,the margins were wide or marginal except for the pedicles,and occasionally the spinal canal and the posterior,where they were accepted to be intralesional.One patient died of metastasis that was not directly related to surgery itself.There was no local recurrence.[Conclusion]The advantages of total en bloc spondylectomy include resection of the involved vertebra(e)in two major blocs,rather than in a piecemeal pattern,and completion of the procedure during one surgical session posteriorly.The"total en bloc spondylectomy"offers one of the most aggressive modes of therapy for primary spinal malignancy.

[Objective]To evaluate the value of distraction osteogenesis for treatment of deformity of spine during development.Distraction osteogenesis could be used for patients with campylorrhachia,dwarfism eccyliosis of spine or those combined with thoracocyllosis and obliquity pelvis.[Method]According to the principle of Halo-pelvic distraction apparatus which was divided into two parts of halo and pelvic,the halo was 4-nail fixation and the pelvic was 2-nail fixation.The halo and pelvic were connected by 4 standing pillar.Through the daily extending of 4 standing pillar the curved spine was extended and stretched gradually.As a result,action of 3D correction of deformity of spine was achieved.[Result]Ten patients of this group were treated by this methods.The action of 3D correction and automatic correction of deformity were showed in 70~120 days distraction that the wedge-shaped vertebra changed into squareness,curved spine was stretched and rotatory vertebra was reduced.[Conclusion]Distraction osteogenesis is a minimally invasive surgery instead of internal fixation of spine for the treatment of deformity of spine during development.

[Objective]To report the records of 185 patients in whom severe scoliosis had been treated with preoperative halo-pelvic distraction and following total spine osteotomy and internal fixation.[Method]Preoperative halo-pelvic distraction was applied to all patients to reduce the severity of curvatures and make the following treatment possible.Then total spine osteotomy and internal fixation were performed to rectify the remained deformity of the spine.Halo-pelvic distraction was maintained during the operation and postoperatively to limit the mobilization of the patients.At one day after the operation,the patients were able to get out of bed,stand up and move around,making nursing care more convenient.[Result]Between 1983 and 2003,a total of 185 cases of severe scoliosis were treated by this approach and an average correction rate of 70.32% was achieved.Complete bone fusions were achieved at the cut ends of thc bone.The average loss of correction rate was less than 5 degrees.In the late stage of postoperative duration,rod release occurred in four cases and was resolved by second surgical intervention,showing no adverse effect on the clinical outcome.At one year postoperative infective complication occurred in one case and the patient fully recovered after the removal of the inserted device.X-ray examination confirmed good healing of the hone grafts.Root pain occurred in one case and the patient gradually recovered without any medical intervention.None of the rest patients had evidence of spinal cord or nervous system complications.[Conclusion]Halo-pelvic distraction instrumenation,in combination with total spine osteotomy,is an effective treatment modality for severe spinal curvatures.Halo-pelvic distraction can facilitate the operative procedure for those cases that can not be cured by application of single instrumentation or have difficulty in the insertion of the internal fixation device.The combined total spine osteotomy can further correct the spinal curves,reduce the burden of the fixafion device and avoid the occurrence of release or break down of the rods,eventually cure the severe scoliosis effectively.

BACKGROUND:Anterior cervical discectomy and fusion surgery is a good choice for repair of degenerative cervical disc herniation, but it is reported that fusion can affect the exercise of cervical neighboring stages. Artificial disc replacement can not only play a role in mitigation of cervical disease neurological symptoms and signs, but also maintain stability and semental activity of cervical spine, and reduce secondary adjacent segmental degeneration.
These two methods which applied in cervical degenerative intervertebral disc herniation stil remain controversial. OBJECTIVE:To investigate the short-term effect of artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single segmental cervical disc herniation. METHODS:Total y 48 patients with single segment radiculopathy or myelopathy cervical diseases induced by cervical disc herniation that required surgery and received a three-month fol ow-up were included and retrospectively analyzed. These patients were divided into replacement group (n=21) and fusion group (n=27) according to the different repair programs. Patients in the replacement group were subjected to Prestige LP cervical artificial disc replacement, and patients in the fusion group were subjected to disc fusion using interbody fusion cage of Johnson or al ogeneic fibularing. They were fol owed up at 1 week, 3, 6, 12, 24, 36 months after treatment. Complications were recorded during the fol ow-up. The pain of patients was evaluated using neck and upper limb pain visual analogue scale scores. The therapeutic effect was evaluated using Japanese Orthopaedic Association (JOA) score. The clinical symptoms improvement and daily functional status of patients after treatment were evaluated using cervical disability index. RESULTS AND CONCLUSION:During the final fol ow-up, the fusion rate in fusion group was 93%(25/27). Comparisons between groups:at the 1 week and final fol ow-up after treatment, the visual analog scale scores of neck and upper limbs and cervical dysfunction indexes were al lower than those before treatment;the Japanese Orthopaedic Association scores were higher than those before treatment (P<0.05). In the final fol ow-up, the visual analog scale scores of neck and upper limbs and cervical dysfunction index were al lower than those after one week of treatment, and the Japanese Orthopaedic Association scores were higher than those after one week of treatment (P<0.05). There were no significant differences in the above indicators at each time point between these two groups (P>0.05). The cervical activity and surgical segmental motion after cervical disc replacement were significantly higher than those in the fusion group;the difference was statistical y significant (P<0.05). There were no serious complications in these two groups. There was no significant difference in the incidence of complications between these two groups (P>0.05). These results suggest that the artificial cervical disc replacement and anterior cervical decompression and fusion for the treatment of single cervical disc herniation have the same effect in terms of patients’ symptoms mitigation. With respect to fusion technique, artificial disc replacement surgery has the advantage of maintaining cervical stability and activities of replacement segments.

BACKGROUND:In recent years, with the continuously improving of the fixation systems and technology, conducting anterior cervical decompression bone graft accompanying with anterior plate fixation have been accepted by most scholars, however, the complications related to this also appeared constantly. In view of this, the zero notch interbody fusion plate (Zero-P) has been approved for the clinical treatment of cervical degenerative disease. OBJECTIVE:To discuss the early application effect of Zero-p on anterior cervical decompression and fusion. METHODS:The study enrol ed 22 patients who underwent anterior cervical decompression and fusion with Zero-P between February and December 2014. The number of Zero-P implanted in the C3-4, C4-5, C5-6 was 1, 3 and 18 respectively. Pain and neurological improvement were evaluated using Visual Analog Scales score and Japanese Orthopaedic Association (JOA) score for al the patients after operation. The X-ray plain of lateral and flexion-extension lateral of cervical vertebra were shot. The degradation degree was judged based on the measurement results from the cervical lateral X-ray films about the ratio of cephalad and caudal adjacent intervertebral space to vertebral body height, and adjacent segments osteoarthritis situation. The abnormal activity at the surgical spaces was observed by the extension and flexion lateral X-ray plain. RESULTS AND CONCLUSION:Twenty-two patients obtained fol ow up for 10-28 months. 2 patients had dysphagia on the fourth day and the fifth day after operation (extremely mild). The symptom disappeared within 2 weeks after treatment. The Visual Analog Scales score was significantly lower compared with preoperation (P<0.05), the JOA score was significantly higher than that before operation (P<0.05) , the cervical Cobb angle was significantly higher than that before operation (P<0.05). There were no significant differences statistical y in comparison of the Visual Analog Scales score, JOA score and cervical Cobb angle at different time points after operation (P>0.05). In cephalad adjacent intervertebral space, 3 cases had developed hyperosteogeny (first level). In caudal adjacent intervertebral space, 1 had developed hyperosteogeny (first level). There was no significant difference in the hyperosteogeny between cephalad adjacent intervertebral space and caudal adjacent intervertebral space (P>0.05). There was no significant difference in the R value in cephalad adjacent intervertebral space and caudal adjacent intervertebral space between preoperation and postoperation (P>0.05). During the fol ow-up, no abnormal activity at the surgical spaces and implant displacement was observed. These results suggest that using Zero-p in the treatment of monosegmental disc disease has significant effect, can effectively improve the cervical curvature and establish good cervical stability. The incidence of postoperative dysphagia is low. The degeneration of adjacent segments after treatment was not increased in early stage.

Objective To establish early diagnosis,treatment and prevention of tuberculosis infection following kidney transplantation.Methods Eighteen post-operative tuberculosis infections were identified among 1024 kidney transplantations performed in Beijing Chaoyang Hospital between January 2002 and December 2009.Triple immunosuppressive therapy strategy was used for these 18 patients.Of the 14 patients who received immune induction therapy,4 were treated with monoclonal antibody,and the other 10 were treated with anti-thymocyte globulin(ATG)or anti-lymphocyte globulin(ALG).Results The interval between renal transplantation and identification of tuberculosis infection ranged from 1 to 54 months.Posttransplant tuberculosis infection showed no typical clinical manifestations at early stage.Persistent or intermittent fever was the main symptom.High resolution CT and bronchoalveolar lavage fluid(BALF)test were useful tools for confirmed diagnosis.After routine anti-tuberculosis treatment,17 patients were cured and 1 patient died.Conclusions The early stage symptoms of post-transplant tuberculosis may be atypical,which could result in misdiagnosis.Pulmonary high-resolution CT examination and BALF test could provide strong evidence for tuberculosis infection.